Study protocol: Optimising patient positioning for the planning of accelerated partial breast radiotherapy for the integrated magnetic resonance linear accelerator: OPRAH MRL.


Journal

Radiation oncology (London, England)
ISSN: 1748-717X
Titre abrégé: Radiat Oncol
Pays: England
ID NLM: 101265111

Informations de publication

Date de publication:
17 Sep 2024
Historique:
received: 13 06 2024
accepted: 04 09 2024
medline: 18 9 2024
pubmed: 18 9 2024
entrez: 17 9 2024
Statut: epublish

Résumé

Accelerated partial breast irradiation (APBI) is an accepted treatment option for early breast cancer. Treatment delivered on the Magnetic Resonance integrated Linear Accelerator (MRL) provides the added assurance of improved soft tissue visibility, important in the delivery of APBI. This technique can be delivered in both the supine and prone positions, however current literature suggests that prone treatment on the MRL is infeasible due to physical limitations with bore size. This study aims to investigate the feasibility of positioning patients on a custom designed prone breast board compared with supine positioning on a personalised vacuum bag. Geometric distortion, the relative position of Organs at Risk (OAR) to the tumour bed and breathing motion (intrafraction motion) will be compared between the supine and prone positions. The study will also investigate the positional impact on dosimetry, patient experience, and position preference. Up to 30 patients will be recruited over a 12-month period for participation in this Human Research Ethics Committee approved exploratory cohort study. Patients will be scanned on the magnetic resonance imaging (MRI) Simulator in both the supine and prone positions as per current standard of care for APBI simulation. Supine and prone positioning comparisons will all be assessed on de-identified MRI image pairs, acquired using appropriate software. Patient experience will be explored through completion of a short, anonymous electronic survey. Descriptive statistics will be used for reporting of results with categorical, parametric/non-parametric tests applied (data format dependent). Survey results will be interpreted by comparison of percentage frequencies across the Likert scales. Thematic content analysis will be used to interpret qualitative data from the open-ended survey questions. The results of this study will be used to assess the feasibility of treating patients with APBI in the prone position on a custom designed board on the MRL. It may also be used to assist with identification of patients who would benefit from this position over supine without the need to perform both scans. Patient experience and technical considerations will be utilised to develop a tool to assist in this process. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN1262400067583. Registered 28th of May 2024. https://www.anzctr.org.au/ACTRN12624000679583.aspx.

Sections du résumé

BACKGROUND BACKGROUND
Accelerated partial breast irradiation (APBI) is an accepted treatment option for early breast cancer. Treatment delivered on the Magnetic Resonance integrated Linear Accelerator (MRL) provides the added assurance of improved soft tissue visibility, important in the delivery of APBI. This technique can be delivered in both the supine and prone positions, however current literature suggests that prone treatment on the MRL is infeasible due to physical limitations with bore size. This study aims to investigate the feasibility of positioning patients on a custom designed prone breast board compared with supine positioning on a personalised vacuum bag. Geometric distortion, the relative position of Organs at Risk (OAR) to the tumour bed and breathing motion (intrafraction motion) will be compared between the supine and prone positions. The study will also investigate the positional impact on dosimetry, patient experience, and position preference.
METHODS METHODS
Up to 30 patients will be recruited over a 12-month period for participation in this Human Research Ethics Committee approved exploratory cohort study. Patients will be scanned on the magnetic resonance imaging (MRI) Simulator in both the supine and prone positions as per current standard of care for APBI simulation. Supine and prone positioning comparisons will all be assessed on de-identified MRI image pairs, acquired using appropriate software. Patient experience will be explored through completion of a short, anonymous electronic survey. Descriptive statistics will be used for reporting of results with categorical, parametric/non-parametric tests applied (data format dependent). Survey results will be interpreted by comparison of percentage frequencies across the Likert scales. Thematic content analysis will be used to interpret qualitative data from the open-ended survey questions.
DISCUSSION CONCLUSIONS
The results of this study will be used to assess the feasibility of treating patients with APBI in the prone position on a custom designed board on the MRL. It may also be used to assist with identification of patients who would benefit from this position over supine without the need to perform both scans. Patient experience and technical considerations will be utilised to develop a tool to assist in this process. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN1262400067583. Registered 28th of May 2024. https://www.anzctr.org.au/ACTRN12624000679583.aspx.

Identifiants

pubmed: 39289753
doi: 10.1186/s13014-024-02517-3
pii: 10.1186/s13014-024-02517-3
doi:

Banques de données

ANZCTR
['ACTRN1262400067583']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

123

Informations de copyright

© 2024. The Author(s).

Références

Trials BC. Breast Cancer Statistics 2020 [Breast Cancer Statistics - Breast Cancer Trials]. Available from: https://www.breastcancertrials.org.au/breast-cancer-statistics .
Youl P, Philpot S, Moore J, Morris M, Theile DE. Trends in surgery and adjuvant treatment for early-stage breast cancer: a population-based study in Queensland. Australia Breast Cancer Res Treat. 2022;193(1):175–85.
doi: 10.1007/s10549-022-06551-1 pubmed: 35254604
Lam J, Cook T, Foster S, Poon R, Milross C, Sundaresan P. Examining determinants of radiotherapy access: do cost and radiotherapy inconvenience affect uptake of breast-conserving treatment for early breast cancer? Clin Oncol (R Coll Radiol). 2015;27(8):465–71.
doi: 10.1016/j.clon.2015.04.034 pubmed: 26009548
Livi L, Meattini I, Marrazzo L, Simontacchi G, Pallotta S, Saieva C, et al. Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer. 2015;51(4):451–63.
doi: 10.1016/j.ejca.2014.12.013 pubmed: 25605582
Meattini I, Marrazzo L, Saieva C, Desideri I, Scotti V, Simontacchi G, et al. Accelerated partial-breast irradiation compared with whole-breast irradiation for early breast cancer: long-term results of the randomized phase III APBI-IMRT-Florence trial. J Clin Oncol. 2020;38(35):4175–83.
doi: 10.1200/JCO.20.00650 pubmed: 32840419
Batumalai V, Delaney GP, Descallar J, Gabriel G, Wong K, Shafiq J, et al. Variation in the use of radiotherapy fractionation for breast cancer: Survival outcome and cost implications. Radiother Oncol. 2020;152:70–7.
doi: 10.1016/j.radonc.2020.07.038 pubmed: 32721419 pmcid: 7382346
Henke LE, Contreras JA, Green OL, Cai B, Kim H, Roach MC, et al. Magnetic resonance image-guided radiotherapy (MRIgRT): a 4.5-year clinical experience. Clin Oncol (R Coll Radiol). 2018;30(11):720–7.
doi: 10.1016/j.clon.2018.08.010 pubmed: 30197095
Groot Koerkamp ML, Vasmel JE, Russell NS, Shaitelman SF, Anandadas CN, Currey A, et al. Optimizing MR-guided radiotherapy for breast cancer patients. Front Oncol. 2020;10:1107.
doi: 10.3389/fonc.2020.01107 pubmed: 32850318 pmcid: 7399349
Fargier-Bochaton O, Wang X, Dipasquale G, Laouiti M, Kountouri M, Gorobets O, et al. Prone versus supine free-breathing for right-sided whole breast radiotherapy. Sci Rep. 2022;12(1):525.
doi: 10.1038/s41598-021-04385-3 pubmed: 35017568 pmcid: 8752750
Wang X, Fargier-Bochaton O, Dipasquale G, Laouiti M, Kountouri M, Gorobets O, et al. Is prone free breathing better than supine deep inspiration breath-hold for left whole-breast radiotherapy? A dosimetric analysis. Strahlenther Onkol. 2021;197(4):317–31.
doi: 10.1007/s00066-020-01731-8 pubmed: 33416915 pmcid: 7987627
Horton JK, Blitzblau RC, Yoo S, Geradts J, Chang Z, Baker JA, et al. Preoperative single-fraction partial breast radiation therapy: a novel phase 1, dose-escalation protocol with radiation response biomarkers. Int J Radiat Oncol Biol Phys. 2015;92(4):846–55.
doi: 10.1016/j.ijrobp.2015.03.007 pubmed: 26104938 pmcid: 4481883
Charaghvandi KR, Van’t Westeinde T, Yoo S, Houweling AC, Rodrigues A, Verkooijen HM, et al. Single dose partial breast irradiation using an MRI linear accelerator in the supine and prone treatment position. Clin Transl Radiat Oncol. 2019;14:1–7.
pubmed: 30406210
Correa C, Harris EE, Leonardi MC, Smith BD, Taghian AG, Thompson AM, et al. Accelerated partial breast irradiation: executive summary for the update of an ASTRO evidence-based consensus statement. Pract Radiat Oncol. 2017;7(2):73–9.
doi: 10.1016/j.prro.2016.09.007 pubmed: 27866865
Walker A, Liney G, Metcalfe P, Holloway L. MRI distortion: considerations for MRI based radiotherapy treatment planning. Australas Phys Eng Sci Med. 2014;37(1):103–13.
doi: 10.1007/s13246-014-0252-2 pubmed: 24519001
Barnes H, Alexander S, Bower L, Ehlers J, Gani C, Herbert T, et al. Development and results of a patient-reported treatment experience questionnaire on a 1.5 T MR-Linac. Clin Transl Radiat Oncol. 2021;30:31–7.
pubmed: 34307911 pmcid: 8283148
Clarke V, Braun V. Thematic analysis. J Posit Psychol. 2016;12(3):297–8.
doi: 10.1080/17439760.2016.1262613
Lai J, Zhong F, Deng J, Hu S, Shen R, Luo H, et al. Prone position versus supine position in postoperative radiotherapy for breast cancer: A meta-analysis. Medicine (Baltimore). 2021;100(20): e26000.
doi: 10.1097/MD.0000000000026000 pubmed: 34011096
Brown E, Dundas K, Surjan Y, Miller D, Lim K, Boxer M, et al. The effect of imaging modality (magnetic resonance imaging vs. computed tomography) and patient position (supine vs. prone) on target and organ at risk doses in partial breast irradiation. J Med Radiat Sci. 2021;68(2):157–66.
doi: 10.1002/jmrs.453 pubmed: 33283982
Groot Koerkamp ML, van der Leij F, van’t Westeinde T, Bol GH, Scholten V, Bouwmans R, et al. Prone versus supine accelerated partial breast irradiation on an MR-Linac: a planning study. Radiother Oncol. 2021;165:193–9.
doi: 10.1016/j.radonc.2021.11.001 pubmed: 34774649
De-Colle C, Nachbar M, Mnnich D, Boeke S, Gani C, Weidner N, et al. Analysis of the electron-stream effect in patients treated with partial breast irradiation using the 1.5 T MR-linear accelerator. Clin Transl Radiat Oncol. 2021;27:103–8.
pubmed: 33553697 pmcid: 7856390
Nachbar M, Monnich D, Boeke S, Gani C, Weidner N, Heinrich V, et al. Partial breast irradiation with the 1.5 T MR-Linac: first patient treatment and analysis of electron return and stream effects. Radiother Oncol. 2020;145:30–5.
doi: 10.1016/j.radonc.2019.11.025 pubmed: 31874347

Auteurs

Jenna Dean (J)

Radiation Oncology, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia. jenna.dean@austin.org.au.
Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia. jenna.dean@austin.org.au.

Nigel Anderson (N)

Radiation Oncology, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia.

Georgia K B Halkett (GKB)

Curtin School of Nursing/Curtin Health Innovation Research Institute, Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.

Jessica Lye (J)

Radiation Oncology, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia.
School of Health and Biomedical Science, RMIT University, 124 La Trobe St, Melbourne, VIC, 3000, Australia.

Mark Tacey (M)

Radiation Oncology, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia.

Farshad Foroudi (F)

Radiation Oncology, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia.

Michael Chao (M)

Radiation Oncology, Olivia Newton John Cancer Wellness and Research Centre, Austin Health, PO Box 5555, Heidelberg, VIC, 3084, Australia.

Caroline Wright (C)

Department of Medical Imaging and Radiation Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Wellington Rd, Clayton, VIC, 3800, Australia.

Articles similaires

[Redispensing of expensive oral anticancer medicines: a practical application].

Lisanne N van Merendonk, Kübra Akgöl, Bastiaan Nuijen
1.00
Humans Antineoplastic Agents Administration, Oral Drug Costs Counterfeit Drugs

Smoking Cessation and Incident Cardiovascular Disease.

Jun Hwan Cho, Seung Yong Shin, Hoseob Kim et al.
1.00
Humans Male Smoking Cessation Cardiovascular Diseases Female
Humans United States Aged Cross-Sectional Studies Medicare Part C
1.00
Humans Yoga Low Back Pain Female Male

Classifications MeSH